Patient – FAQ’s

Frequently Asked Patient Questions (FAQ’s)

1. What are the eligibility requirements?

To be eligible:

1. You must not have any type of dental insurance including: private dental insurance, government provided dental coverage, MediCal, CenCal or any other type of dental insurance.
2. Household income must not be more than 200% of the 2014 Federal Poverty Level for all household members.
3. You must be 18 years old or older.

2. What are the income levels for 200% of the 2014 Federal Poverty Level?

Number in Household Monthly Income Yearly Income

1 person $1,915 $22,980

2 persons $2,585 $31,020

3 persons $3,255 $39,060

4 persons $3,925 $47,100

5 persons $4,595 $55,140

6 persons $5,265 $63,180

7 persons $5,935 $71,220

8 persons $6,605 $79,260

For each additional person, add $9,900 per year.

3. What does “Household” mean?

Household: Members of an immediate family who live in the same residence make up a household. That includes parents, sons, daughters, grandparents and children for whom the parents have legal custody.
Children living in the same household as their parents, under the age of 18, will be considered part of the household. Children who do not live with their parents may be included on an application if the parent can show that they support the child financially.
Others living in the household, such as sisters, brothers, aunts, uncles or friends must apply separately.

Individual: A single person who lives alone or resides with others but does not qualify as a member of their household.

4. How do I verify my income in order to qualify? You must produce proof of income for the past 6 months for everyone in your household.

Federal tax return for the last year PLUS:

• Copy of the last three pay stubs from every person who works in the household;
• Unemployment benefits statement and proof of current payment history;
• Proof of social security/disability income or retirement/pension benefits. If you have direct deposit for these checks, you must provide a bank statement;
• Child support/alimony support documentation.
• If you are paid in cash, your employer must provide a letter verifying your income with contact information.
• If self-employed, bring a Profit and Loss statement or a record of state tax sales revenue for past year.
• If living on savings, you must provide three of your most recent bank statements.
• If no income, we require a letter of support from the person who provides food and shelter for you.

5. Why do I need to provide verification of income?
The Noor Dental Clinic is a non-profit, FREE dental clinic. We depend entirely on donations and grants to fund our operations. We also depend on volunteers (dentists, dental assistants, hygienists and front office staff) to operate our dental clinic. Because of these limited resources, we cannot provide services for everyone who needs dental services. We have established eligibility rules so that we can provide services to those who have the greatest need for dental care and do not have the resources to obtain them.

6. How do I get on the waiting list?

In order to qualify, you must meet all of our eligibility requirements. First, you must complete a Noor Dental Clinic Application form. Your application is reviewed. If it is determined that you are NOT eligible based on your answers on your application, you will be notified.
If you are eligible, you will then be placed on a waiting list. Every month, we select people on the waiting list for interviews. At that time you will be contacted and we will request that you provide documents such as proof of income and identity. If you meet all of our eligibility requirements, we contact you to schedule an appointment as soon as they become available in the coming month.7. How long will it be before I will be seen at the dental clinic?

Because of the huge demand for dental services, we have a big waiting list with wait times of months, or in some cases, a year or more.

8. Will I be charged for any of the dental services that I receive?

No, all services provided at the Noor Dental Clinic are free. However, in some cases, we may need to refer you to dentists who can provide the specialized dental care you need. In those cases when we refer you to outside dentists or dental labs, you may be responsible to pay this dentist or dental lab for their services. In many cases, these dentists have agreed to a reduced payment.

9. What are the hours of operation?

We are normally open Wednesdays and Fridays. Our hours of operation vary depending on the availability of our dental volunteers. Please call ahead to get hours of operation for a particular day.

10. What are my responsibilities as a patient:

a. Keep your appointments. If you fail to keep your appointments, you can be removed from the program. There are many people in our community who desperately need dental care. We discharge patients from the Noor

Dental Clinic for not keeping appointments. Please be on time or early for your appointments. You will be discharged from the Clinic and not receive further care if you:

● No-show for 2 appointments. A cancellation of less than 24 hours ahead of your appointment is considered a no-show.
● Cancel or are late for more than 2 appointments. A cancellation less than 24 hours ahead of your appointment is considered a no-show.

b. Proper dental care. We expect you to take care of your teeth. If you are not conscientious about your dental health, the work we do on your teeth will not be as effective as it should be.

11. What other things do I need to know about the Noor Dental Clinic?

• NOOR DENTAL CLINIC is not a walk-in clinic. Patients must complete an application form and be eligible for services. We see patients by appointment only.
• NOOR DENTAL CLINIC does not provide services for individuals whose injuries are covered by Worker’s compensation or for individuals seeking payments for injury through lawsuit or legal action.
• NOOR DENTAL CLINIC DOES NOT PRESCRIBE OR DISPENSE CONTROLLED SUBSTANCES OR NARCOTICS.
• In order to receive services when you need an interpreter, you must bring one with you that is over the age of 18 years and able to speak English fluently.
• NOOR DENTAL CLINIC is staffed primarily by volunteers who give their time without compensation.
• NOOR DENTAL CLINIC is supported by contributions from individuals, businesses and foundations, grants and patient donations.
• Your personal information is confidential and will be shared only with medical providers participating in your care.
• The Noor Dental Clinic does not discriminate against patients on the basis of race, sex, color, age, national origin, sexual orientation or disability.